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Initial Evaluation of the Normal Newborn

By

Deborah M. Consolini

, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Last full review/revision Sep 2021| Content last modified Sep 2021
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Topic Resources

Hand washing is critical for all personnel to prevent transmission of infection.

Active participation in the birth by the mother and her partner helps them adapt to parenting.

Immediately at delivery, the neonate’s respiratory effort, heart rate, color, tone, and reflex irritability should be assessed; all are key components of the Apgar score assigned at 1 minute and 5 minutes after birth (see Table: Apgar Score Apgar Score Hand washing is critical for all personnel to prevent transmission of infection. Active participation in the birth by the mother and her partner helps them adapt to parenting. Immediately at... read more ). Apgar scores between 8 and 10 indicate that the neonate is making a smooth transition to extrauterine life; scores 7 at 5 minutes (particularly if sustained beyond 10 minutes) are linked to higher neonatal morbidity and mortality rates. Many normal neonates have cyanosis 1 minute after birth that clears by 5 minutes. Cyanosis that does not clear may indicate congenital cardiopulmonary anomalies or central nervous system (CNS) depression.

Table

Apgar Score

Score*

Criteria

Mnemonic

0

1

2

Color

Appearance

All blue, pale

Pink body, blue extremities

All pink

Heart rate

Pulse

Absent

< 100 beats/minute

> 100 beats/minute

Reflex response to nasal catheter/tactile stimulation

Grimace

None

Grimace

Sneeze, cough

Muscle tone

Activity

Limp

Some flexion of extremities

Active

Respiration

Respiration

Absent

Irregular, slow

Good, crying

* A total score of 7–10 at 5 minute is considered normal; 4–6, intermediate; and 0–3, low.

Subsequently, the neonate is bathed, wrapped, and brought to the family. The head should be covered with a cap to prevent heat loss. Rooming-in and early breastfeeding should be encouraged so the family can get to know the infant and can receive guidance from staff members during the hospital stay. Breastfeeding Breastfeeding (See also Nutrition in Infants.) Breast milk is the nutrition of choice. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 6 months and introduction... read more is more likely to be successful when the family is given frequent and adequate support. (See also Care of the Normal Newborn Care of the Normal Newborn While in the hospital, new parents should be taught how to feed, bathe, and dress their newborn and become familiar with the newborn's activities, cues, and sounds. Before hospital discharge... read more .)

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